VAP Test Improves Cardiovascular Risk Determination

Most adults who are getting regular preventive healthcare are familiar with the lipid panel performed as a routine check for cholesterol levels. What they may not know is that the standard lipid panel can only identify about 40% of the people who are at high risk for heart disease. The result of this is that many adults mistakenly believe they have reduced their heart attack risk when they are actually carrying around ticking time bombs that could be defused with improved treatment.

While the exact treatment for blood lipid problems varies, doctors seldom consider any such treatments without the test data to justify them. You could argue that the conventional cholesterol test actually increases the risk for heart attacks by leaving people unwisely complacent because of incomplete and inaccurate information about the nature of the fats in their blood. For instance, the LDL cholesterol number for “bad” cholesterol in the conventional tests is just a calculated estimate, not a direct measurement. It could be off significantly.

The VAP Cholesterol Test

A newer procedure called the VAP™ Blood Test (for Vertical Auto Profile) helps improve the ability to identify blood lipid patterns associated with heart attacks and cardiovascular disease. Atherotech, the company providing the test, estimates that it can identify twice as many patients at high risk for heart attacks than regular cholesterol lipid panel tests and also identify patients likely to develop type 2 diabetes and cardiovascular disease that may not lead to heart attacks.

But for nearly half of all individuals who have suffered a heart attack, the standard lipid profile reveals no abnormalities. According to Atherotech, the VAP test will be able to identify twice as many individuals at risk for heart disease, when compared to traditional techniques.

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In addition, the VAP test provides individuals with a better idea of their vulnerability to the metabolic syndrome, a combination of factors that significantly elevate the risk an individual will develop diabetes or cardiovascular disease.

Confusing Connections Between Cholesterol and Heart Disease

While cholesterol does have something to do with heart disease risk, many people are confused about the connection. Even doctors often don’t understand it as fully as their education may have been years ago, before many inaccurate beliefs were identified and corrected.

Simply avoiding high total cholesterol isn’t enough to ensure low cardiovascular disease risk. There are a large variety of risks that are likely to be even more significant than high cholesterol levels. But even within just the category of cholesterol tests alone, there are particular areas of concern that are often not measured by the tests commonly prescribed by typical doctors. For instance, having predominantly small and dense LDL cholesterol is a significant risk factor even if your LDL cholesterol is below 100 mg/dL as it optimally should be. Too many in the medical establishment have bought into “big pharma” pushing of statin drugs as the ultimate solution as they inaccurately believe high total and LDL cholesterol are the exclusive risk factors for cardiovascular diseases. As cardiovascular surgeon Dr. Michael Ozner points out in his book The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will), many of the therapies and surgeries for cardiovascular disease that are common in the United States are probably unnecessary, raise health care expenses, and don’t really improve overall outcomes. Much better than surgeries would be to prevent cardiovascular disease in the first place. You must have the test data to know what risks apply to you and to quantify how your treatment is progressing so it can be adjusted as necessary. The VAP cholesterol test can help do a better job than conventional cholesterol tests at detecting risks you have from the fats in your blood. From that information, you can help determine what lifestyle, diet, supplement, and medicine changes you should consider and then can verify with retests that the plan is having a beneficial effect.

As Dr. Ozner states, lifestyle, diet, and nutritional supplements can do a great deal to reduce cardiovascular disease risk:

If we want to stop heart disease, we have to address the underlying causes: cholesterol levels, free radical production, inflammation. The good news is that, because heart disease is a metabolic disorder, all of these things are, to a certain degree, within our control. No one has to die prematurely from heart disease.

Preventing heart disease is in large part a matter of simply encouraging a healthy metabolism: eating the right foods, getting plenty of exercise, and avoiding chronic stress. And you can reverse heart disease the same way. Studies have shown this again and again, including one study published by Harvard-based researchers in the New England Journal of Medicine that concluded that lifestyle changes (diet, exercise, etc.) are capable of reducing cardiovascular disease risk by more than 80 percent—a figure which trumps even statin drugs, known to reduce the relative risk of cardiovascular disease risk by 30 to 35 percent.

Five common myths about cholesterol testing and heart attack risk that are widely believed by the public, media, and even some doctors are:

Myth No. 1: If my total cholesterol and bad (LDL) cholesterol are “normal,” I don’t need to worry about heart disease.

Wrong. Even patients who get their cholesterol test results back as “normal” may be at risk for heart disease. In fact, almost half of all patients who have heart attacks have “normal” cholesterol levels, as measured by the standard cholesterol test. A new, expanded cholesterol test, however, identifies a far greater number of patients at risk of heart disease than the routine cholesterol tests. Like the standard tests, which have been available since the 1970s, the VAP™ test provides total cholesterol, high-density lipoprotein (HDL, the “good” cholesterol), low-density lipoprotein (LDL, the “bad” cholesterol), and triglycerides. Advanced technology allows the VAP Test to break down these cholesterol components further, providing new information that can help physicians better assess the risk of heart disease in their patients.

Myth No. 2: If I exercise and eat healthy, I don’t need to worry about heart disease.

That’s another fallacy. Many people who are at risk or already suffer from heart disease exercise and eat right. That’s because genetics play a significant role in heart disease. In fact, a recent study of male twins, one lean and athletic and the other heavier and more sedentary, found that the brothers tended to show the same cholesterol response to high-fat and low-fat diets—even though their exercise habits were dramatically different. The study exemplifies the importance of finding out your true risk for heart disease by delving deeper into your cholesterol levels. The VAP™ test measures cholesterol subclasses that provide important genetic clues to your overall cardiovascular health.

Myth No. 3: Women aren’t as susceptible to heart disease as men.

This myth couldn’t be further from the truth. Cardiovascular disease is the No. 1 cause of death in women. In fact, nearly twice as many women in the United States die of heart disease and stroke as from all forms of cancer, including breast cancer. High cholesterol is a major risk factor for heart disease and also increases the risk of stroke. Women who’ve reached their forties also tend to have higher cholesterol levels than men. In addition, research has shown that low levels of HDL appear to be a stronger risk factor for women than for men. For these reasons, it is especially important for women to have an accurate and detailed cholesterol measurement, such as the one provided by the VAP™ test.

Wrong again. A little known fact about the routine cholesterol test is that it estimates LDL, rather than directly measuring it. This process can result in a significant under-estimation of a patient’s LDL level—and heart disease risk. The VAP™ test directly measures LDL, resulting in an accurate measurement with little or no variation.

Myth No. 5: If my HDL, or “good” cholesterol, is high, I am more protected against heart disease.

This may appear to be true, but there is a catch: HDL is actually made up of HDL2 and HDL3. While people with a higher level of HDL2 are more protected against heart disease, those with more HDL3 actually may be at increased risk for heart disease—even if they have normal total HDL cholesterol. It’s important to be aware of HDL subclass measurements, especially if there’s a history of heart disease in your family. The VAP™ test breaks down HDL measurements to accurately assess your cholesterol—and heart disease—risk.

Understanding Cardiovascular Disease Risk

This informative 10 minute long video linked below features Dr. Michael Smith giving an overview of cardiovascular disease, determining risk via testing, and improving health by the use of nutritional supplements. He explains how atherosclerosis, one of the most common cardiovascular diseases, occurs within the blood vessels. Atherosclerotic plaque that breaks lose is one of the major causes of heart attacks. He lists several tests, including the VAP™ Blood Test, that you can use to determine your cardiovascular disease risk. He also discusses a range of nutrients that can be used to improve your cardiovascular health, particularly if your test results show you’re at risk. These include pomegranate extract, cocoa extract, CoQ10, reseveratrol, GliSODin, vitamin K2, omega 3 fatty acids, citrus pectin, and garlic extract that can help prevent and heal cardiovascular diseases.

Example of Actual VAP Test Results

From the VAP™ test, you get detailed information using actual measurements, not calculated estimates. So you can see what the VAP test results look like, we’ve obtained a sample test from a real live patient, redacted it to remove personal identification information, and put in this VAP test PDF file. Click on the link to bring up the test report in a PDF viewer window.

The patient is a fairly typical American male in his 40’s. A conventional cholesterol test for this person would show the following results which you can see at the top of the results section of the PDF file:

Lipid Test

Result

Total Cholesterol

153 mg/dL

LDL Cholesterol

98 mg/dL

HDL Cholesterol

32 mg/dL

Triglycerides

159 mg/dL

From those results, a typical doctor would say the patient’s HDL is a little low, overall cholesterol looks OK and maybe even a bit low, and triglycerides are a touch high. This person probably would not be viewed as a high risk patient based upon those results. A typical doctor would probably say to exercise a little more and cut back on sugars and fats in the diet.

By comparison, what you can see on the VAP test report is a lot more detail that shows that this person actually is in worse shape than it might seem from the usual tests. The person’s LDL cholesterol tends to be of the small, dense type that breaks through arterial walls and causes inflammation. The person also has high VLDL (Very Low Density Lipoprotein) cholesterol. The size/shape pattern of the LDL cholesterol is considered abnormally dense. The total HDL of 32 is actually worse that it appears because it is mostly the less helpful HDL3 type, not the more protective HDL2. Finally, the test results conclude he’s at high risk for metabolic syndrome which includes obesity, type 2 diabetes, and cardiovascular disease. Overall, this person is at much higher risk for cardiovascular disease than a conventional cholesterol test would have him believe.

While the VAP test doesn’t tell you what to do to fix problems found, it at least does a much better job finding them than typical testing.

However, there are serious limitations to relying solely on the standard cholesterol panel. Most important, it can identify only about 40% of patients at risk for coronary heart disease.2 The truth is, many risk factors are involved in the development of heart disease, and for some people, high cholesterol may or may not be one of them. The well-known Framingham Study illustrated that the higher the cholesterol, the higher the statistical risk of a heart attack.3 Nonetheless, a frightening number of heart attacks still occur every day in people whose cholesterol values are seemingly normal. In fact, the American Heart Association reports that 50% of men and 64% of women who died suddenly of coronary heart disease had no previous symptoms!1

Even Celebrities With Top-Notch Healthcare Are At Risk

In 2004, President William Clinton had quadruple bypass heart surgery. His medical test results were reported yearly to the public when he was in office. The results really weren’t all that bad, yet he ended up with chest pains and shortness of breath that were symptoms of cardiovascular diseases that was treated by extensive heart surgery. Being led down the road to complacency is one of the major concerns for anybody who cares about their health. Clinton had this happen to him, despite having access to far more comprehensive medical care than most people. What he didn’t know might have killed him.

One of the unique aspects of being president of the United States is that details of your medical history are made public every year. According to the results of the last exam performed before he left the White House, Bill Clinton’s total cholesterol was 233 mg/dL, which is not outrageously high. Since optimal cholesterol levels are now considered below 200 mg/dL, the news media made a big deal over the fact that Clinton’s cholesterol was too high.

A more significant problem that the news media only touched on was that the former president’s LDL level was a dangerous 177 mg/dL. New guidelines call for LDL to be below 100 mg/dL, and some doctors want LDL to be below 70 mg/dL in those suffering from coronary artery disease.2 The Life Extension Foundation was first to advocate that LDL levels should be below 100 mg/dL. Until recently, most mainstream doctors believed that an LDL of 130 mg/dL was all right.

Clinton’s blood pressure of 136/84 used to be considered acceptable, but conventional medicine has finally realized that blood pressure over 119/79 exposes one to greater risks of coronary artery disease, stroke, kidney failure, and other diseases. One of the drawbacks of being president is that you get free health care provided by government doctors who are not always up to date on new disease risk factors.

Interestingly, Clinton was prescribed cholesterol-lowering medication before he left the White House, but decided on his own to stop taking the drug after losing some weight. Without first verifying that LDL and cholesterol levels are in safe ranges using a simple blood test, discontinuing any lipid-lowering therapy is a risky strategy. Regrettably, side effects from cholesterol-lowering drugs cause some patients to stop taking them without informing their doctors.

Who Should Get the VAP Test?

Considering how common it is to have relatively decent looking conventional lipid test results yet have serious unknown risk factors that the VAP test could find, I’d encourage anybody who is overweight (Body Mass Index over 25) or obese (BMI over 30) and people over age 30 to get the VAP test at least once in place of their regular cholesterol screening. If you don’t know your BMI, visit Calculate Your Body Mass Index to compute it. It’s being reported that medical insurance and Medicare will often cover the cost of the VAP test:

The VAP Test, which is covered by most insurance carriers and Medicare, provides physicians with direct measurement of LDL, HDL and all relevant cholesterol subclasses. These important but often overlooked subclasses include non-HDL, particle number as determined by accurate apoB, and emerging risk factors such as Lp(a), low-density lipoprotein remnants and small dense LDL.

VAP technology has been used in more than 100 clinical trials and will continue to play an important role in clinical practice and as a valuable analytical research tool. The VAP Test is available nationwide.

You can’t really replace the CBC test with the VAP test because CBC includes a lot of other critical measurements such as liver function tests including AST, ALT, and Alkaline Phosphatase, blood chemistry including levels of iron, calcium, potassium, and chloride, blood cell counts of red blood cells and immune cells, and blood glucose. Some newer CBC tests include an estimated VLDL cholesterol result, too, but this is not from direct measurement.

One way to make use of the VAP test would be to get one along with a CBC, then retake the VAP test every couple of years or when your CBC lipid results (total, LDL, and HDL cholesterol plus triglycerides) change significantly. It’s probably reasonable for most people to consider stable CBC lipid results mean that the VAP test results would not have changed much.

VAP Test Pricing

If your insurance won’t cover it, the cost of the VAP™ Blood Test for Life Extension members at the time of this writing is $185, $247 for non-members.

Life Extension’s prices on blood tests are usually better than what you would be charged by a doctor’s office. But I did a little competitive shopping and found PrePaidLab.com’s VAP test being sold for $103.80, a savings of more than $80 from Life Extension’s member price. Collection is done by the same LabCorp labs that Life Extension uses, and processing is also done by Atherotech.

If you want to go “beyond” the standard lipid panel, then either request the NMR LipoProfile test or a measurement of apolipoproteinB (apoB). Note – the VAP test “calculates” apoB, and this calculation has not been scientifically validated. Measurements (not “calculations”) of apoB are the way to go.

Thanks for mentioning the NMR LipoProfile test. It is another test that does a better job than the standard cholesterol lipid panel. I’ll look into it further. At first glance, it looks price-competitive with the VAP test and has many similarities. It has some of the same kinds of measurements, but from this sample NMR LipoProfile it’s not clear it is as complete. I’ll have to read more about it. For anybody who is reading this comment before I get a chance to provide more information, it looks like there’s an article on the NMR LipoProfile test at Free the Animal: NMR LipoProfile.

You’re right the apoB value in the VAP test is calculated. Direct measurement probably would be better. But Atherotech did do a fairly large study of 1797 patients comparing their calculation and direct measurement and found the errors were relatively small, unlike the kinds of massive errors that happen with LDL calculations. This study was also peer-reviewed, presented, and published.

Q: How accurate is the apo-B data in determining risk compared with the gold standard?

A: Atherotech has developed a novel procedure to calculate apoB utilizing non-HDL-cholesterol along with lipoprotein density distribution using the patented VAP ultracentrifugation method. Atherotech has thoroughly validated this new procedure by comparing its calculated apoB with the gold standard* using serum from 1,797 patients. This comparison has yielded an excellent correlation coefficient (r = 0.96) with bias of only 3.8%. The long term (40 days) reproducibility of VAP apoB is 3.0% CV (coefficient of variance). The VAP apoB calculation work was accepted through a peer review process for presentation at 2007 Annual Meeting of American Association of Clinical Chemistry (AACC), and was subsequently published by AACC as an abstract.

It is true that the VAP test has been utilized in numerous published trials, but as I stated above, none of these are OUTCOMES trials. There is zero peer-reviewed data showing that the VAP test predicts cardiovascular disease and event OUTCOMES better than standard lipid panels. The only published “outcomes” data with VAP was from the Bogalusa Heart Study, and it was a negative trial (VAP did no better than standard lipids).

The NMR LipoProfile test and measured (not calculated) apoB tests, on the other hand, are supported by a large body of published outcomes data, and have been recognized by expert panels from the American Diabetes Association (ADA), American College of Cardiology (ACC), and the American Association for Clinical Chemistry (AACC – lab experts). The VAP test has not been recognized by these expert panels (although Atherotech has been quoted by the media and issued press releases falsely claiming that VAP has been recognized by ADA & ACC).

Atherotech also likes to claim that their calculation of apoB is “peer reviewed.” In reality, a poster of their study was accepted (via a low level “peer-review” process) for presentation at an American Association for Clinical Chemistry meeting and the ABSTRACT was published – along with abstracts from ALL OTHER POSTERS at the meeting. This type of low level review and publication of an ABSTRACT does not constitute a traditional (much more rigorous) “peer review” process.

VAP’s apoB calculation is based upon the high level of correlation between non-HDL-C and measured apoB. This correlation has been addressed by experts from the ADA, ACC, AACC, and the Thirty-Person Ten-Country Panel, all of whom conclude that the correlation is of limited clinical value because non-HDL-C and apoB and only “moderately concordant.” In other words, if I test 1000 people, non-HDL-C and measured apoB will agree strongly (be highly correlated) at a population level, but many not agree strongly (not be concordant) at an individual patient level.

“Calculated apoB” is merely Atherotech’s attempt to keep their cholesterol-based VAP test relevant in a world that is moving away from cholesterol and toward lipoprotein particle number testing (LDL-P by NMR and measurements of apoB).

I have extensive documentation on all topics discussed above, and would be happy to share this information upon request.

I’ve been meaning to write an article on the NMR LipoProfile test to discuss some of Marc’s thoughtful points in his comments above.

While I haven’t had a chance to do so yet, I thought I’d mention that it does seem to be well-designed and like the VAP test is far better than the regular cholesterol panels. As Marc explains, rightly I think, it’s arguable that the NMR test is better than the VAP test in at least some ways, in particular via the direct measurement of the small-particle LDL cholesterol count.

I found a vendor that offers the NMR LipoProfile test for considerably less (about 1/3 less!) than the VAP cholesterol profile. Click through NMR LipoProfile test for $69.60 to see how to order it.

With the understanding that this article was written nearly 3 years ago, I feel it necessary to comment on some ‘facts’ that are offered by Marc that are inaccurate in 2012. The VAP is indeed supported and recognized by multiple large governing medical bodies including, but not limited to, the ADA (American Diabetes Association) and ACC (American College of Cardiology). Atherotech does offer direct measure ApoB and Apo A1, contrary to previous comments. And if you take the time to read the ATP-III recommendations, which are the gold standard for detection, evaluation, and treatment of cholesterol problems, it will be quite apparent that the VAP is the only test currently available that conforms and reports to all the ATP-III guidelines for primary, secondary, and emerging risk factors. In fact, the method by which VAP results are determined, ultracentrifucation, are specifically mentioned in ATP-III. Finally, the VAP is $39 when ordered directly through Atherotech, compared to $20-$45 for a basic calculated lipid panel, and $89-$169 for NMR.